Interventional Oncology, Zietman, and Harvard

Discussion in 'Radiation Oncology' started by Impressions, Jan 4, 2009.

  1. Impressions

    Impressions Membership Revoked
    Removed 2+ Year Member

    Joined:
    Mar 8, 2006
    Messages:
    405
    Likes Received:
    1
    I'm sure a good number of you saw this article in the July edition of Seminars in Radiation Oncology:

    The future of radiation oncology: the evolution, diversification, and survival of the specialty. Zietman A. Semin Radiat Oncol. 2008 Jul;18(3):207-13.

    Zietman's article was, for me (although only a trainee), a canary-in-the-coal mine wake-up call regarding the future of a specialty that many of us love. The most fascinating aspect of the piece was his argument for possible long-term strategies to avoid clinical irrelevance, namely the idea of the radiation oncologist as an interventionalist; performing chemoembolization, radioembolization, in addition to our current tasks. This has obvious appeal for a variety of reasons (we already carry out interventional procedures such
    as brachytherapy; like interv. cardiologists, we have clinical knowledge regarding the disease on which the intervention is focused,etc,etc). Zietman mentions that the ABR is willing to consider individual requests by training institutions to test-pilot the above idea. The HROP program seems ideally suited to such a task--with its multi-institutional setting, huge clinical volume, varied expertise, and guaranteed, continuous year of research; imagining current residents using the research year as a first year "fellowship" in diagnostic radiology, followed by an additional year subsequent to completion of RadOnc in the interventional aspects of treatment, doesn't seem far fetched.

    Ultimately, one can envision training in interventional oncology integrated into RadOnc residency (and available to radiologists as part of a fellowship), but clearly some sort of bridge program would be needed to train this first generation of sub-specialists.

    My questions are these (perhaps Stephanie can weigh in here):

    1) Where is this idea currently? Has HROP made any efforts to realize it?

    2) If so, are any current residents pursuing it?

    3) Are any other institutions taking up the idea?


    Thanks!
     
  2. Fascinating stuff. Certainly interested to see where this idea goes....
     
  3. Dwight7298

    2+ Year Member

    Joined:
    Oct 12, 2007
    Messages:
    41
    Likes Received:
    0
  4. hypersomniac_

    hypersomniac_ zzzzzzzzzz
    5+ Year Member

    Joined:
    Oct 20, 2005
    Messages:
    12
    Likes Received:
    0
    This is an interesting idea. I think a logical precedent is clearly set by IR - radiologists don't really get more procedural training than rad onc and yet with appropriate fellowships they can do a wider scope of intervention than is being proposed here.

    The question is referrals to actually do these things. Is there much hope of "interventional oncology" catching on outside either huge academic centers or places where there are no surgical oncologists? Much like IR vs. vascular, the people furthest down the referral chain seem to always get the shaft.
     
  5. RadtionVacation

    2+ Year Member

    Joined:
    Apr 27, 2008
    Messages:
    15
    Likes Received:
    0
    Status:
    Resident [Any Field]
  6. Ursus Martimus

    Ursus Martimus Ursus Martimus
    10+ Year Member

    Joined:
    Apr 19, 2004
    Messages:
    248
    Likes Received:
    0
    Sounds like some combination of RFA and sirspheres, at least in principle. I participated in a yittrium 90 sirsphere treatment for liver mets with the interventional radiologist. I found it to be mind numbingly boring. I suppose however if you like threading catheters through vessels over guide wires and wearing samarai lead aprons because of the fluoro, it might be your thing. But then you might have been an interventional cardiologist instead. My imprerssion: cool idea but in practice not very fun - and remember, it is only palliative.
     
  7. radiaterMike

    radiaterMike Junior Member
    10+ Year Member

    Joined:
    Feb 11, 2005
    Messages:
    360
    Likes Received:
    50
    About half of what a radiation oncologist does is palliative. We should not be turning our noses up at palliative care.
     

Share This Page